Healthcare Provider Details

I. General information

NPI: 1417810854
Provider Name (Legal Business Name): ANNE PALACIOS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/03/2025
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

280 CASEY RD
MOORPARK CA
93021-1131
US

IV. Provider business mailing address

1353 VILLAGE CT
SIMI VALLEY CA
93065-4313
US

V. Phone/Fax

Practice location:
  • Phone: 805-517-1722
  • Fax:
Mailing address:
  • Phone: 805-517-1722
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number402188
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: